GI Flashcards
1
Q
Secretin
A
Produced by Duodenal S-endocrine cells → increases bicarb secretion from pancreas into small bowel
2
Q
Risks of TPN (total parenteral nutrition)
A
Increased risk of gallstones as result of biliary stasis from decreased CCK due to absent enteral stimulation
3
Q
Zenker Diverticulum Caused by _____
A
Cricopharyngeal motor dysfunction → increased pressure
4
Q
Meckel Diverticulum is a remnant of ______ vs Cyst/Fistula from Bladder is from _________
A
- Yolk Sac (vitelline duct)
- Allantois (urachus)
5
Q
Lesser Omentum
A
On lesser curvature and is made up of hepatoduodenal (portal vein, hepatic artery, common bile duct) and hepatogastric ligaments
6
Q
Globus Hystericus
A
“Lump in throat”, fairly common, triggered by emotions
7
Q
Effect of Portal HTN on Splenic Vein
A
Portal hypertension in cirrhosis → splenic vein hypertension and splenomegaly (due to venous accumulation) → congestion of blood in spleen → apparent red pulp expansion
8
Q
Ischemic Colitis
A
Mucosal hemorrhage and patchy
- Aw/ severe atherosclerosis (may have weak lower extremity pulses)
9
Q
Effect of Bile Acids on Microbes
A
Bile acids can emulsify the membranes of microbes in gut (may have bacterial overgrowth without them)
10
Q
Crohn’s MC in:
A
Terminal Ileum
11
Q
Lactulose
A
Treats hepatic encephalopathy by acidifying GI tract contents
12
Q
Ethylene Glycol Poisoning
A
Sudden onset back pain, hematuria, and oliguria w/ high anion gap metabolic acidosis
- Calcium oxalate crystals in urine
13
Q
Brunner’s glands, Crypts of Leiberkuhn, and Goblet Cells
A
- In submucosa of the duodenum secrete alkaline fluid
- Crypts of Leiberkuhn deliver secretions and where stem cells reside
- Goblet cells make mucus
14
Q
OATP
A
Liver takes up unconjugated bilirubin passively through OATP (organic anion transporting polypeptide)
- MOAT is to transport out conjugated bili (active transport)
15
Q
Fitz-Hugh-Curtis
A
Neisseria Gonorrhea, violin string adhesions to liver
- Different from Waterhouse Friedrichson (Neisseria meningitidis, hemorrhaging adrenal crisis)
16
Q
7-a-Hydroxylase
A
Converts cholesterol to bile acids
- Inhibited by fibrates → excess cholesterol in bile → cholesterol gall stones
17
Q
Main Site of Lipid Absorption
A
Jejunum
18
Q
Damage to Hepatocytes in HepB due to:
A
CD8 mediated damage to infected hepatocytes due to presence of the virus causes (HepB does not have cytotoxic effect)
19
Q
Window Period for HepB
A
HBsAg and HBsAb are both undetectable
20
Q
Intussusception
A
MC bowel obstruction from 3mo-6yrs (peak b/w 5-10mo)→ currant jelly stools
- telescoping bowel
21
Q
Congenital pyloric stenosis
A
3-4 week old w/ projectile vomiting and olive mass in abdomen
22
Q
Ascaris Lumbricoides
A
- High pitched tinkly/steel drum bowel sounds
- Can cause Type 1 hypersensitivity
- Most potent allergen
23
Q
Stool Findings for: Strongyloides roundworm Tapeworms Protazoa (Giardia, Histolytica) Schistosomiasis
A
- Strongyloides roundworm: rhabditiform larvae in stool
- Tapeworms: proglottids
- Protazoa (giardia, histolytica): trophozoites and cysts
- Schistosomiasis: eggs
24
Q
Risk of Using Fibrates and Bile-Acid Binding Resins Together
A
Gallstones
25
Bile Acid Binding Resins (cholestyramine)
- Side effects: increased triglycerides and cholesterol gallstones
- Often used with statins, but should be taken at least 4 hours apart because it decreases statin absorption
- also increase hepatic cholesterol synthesis
26
Menetrier's Disease
Protein losing enteropathy due to excess mucus production (mucin cell hyperplasia)
- commonly in elderly
27
Villous Adenomas
- Can secrete large amounts of mucus → secretory diarrhea
- Can be cauliflower like shaped projections
- Risk of colorectal cancer
28
Esophageal Varices
Portal HTN → anastomosis of left gastric (portal) with esophageal veins (caval system)
29
Caput Medusa
anastomosis of paraumbilical veins (portal) with superficial abdominal veins
30
Internal Hemorrhoids
anastomosis of superior rectal veins (portal) with inferior rectal veins
31
HNPCC
(Lynch Syndrome)
MLH1 and MSH2 gene mutations
- mismatch repair problem
32
Fulminant Liver Failure in Pregnant Women
HepE
33
Hep B
- usually sexually transmitted
| - integrates into genome
34
Hep C
- usually IV drug abuse
| - RNA w/o reverse transcriptase so cannot integrate into genome
35
Hep A
- fecal oral
| - dark urine due to increased serum bilirubin
36
Plummer Vinson Triad
atrophic glossitis, iron deficiency, esophageal webs
| - also increased risk squamous cell carcinoma
37
ETEC
- traveler’s diarrhea
| - LT enterotoxin is a cholera-like toxin
38
Air in Biliary Tree
Fistula between gall bladder and bowel allows stone into gut and it will get stuck at ileocecal valve (gallstone ileus)
39
Upper Glandular Gastric Layer
Parietal Cells (secrete acid)
40
Deep Glandular Gastric Layer
Chief Cells (secrete pepsinogen)
41
Hepatoduodenal Ligament
portal vein, hepatic artery, and common bile duct
42
Systemic Mastocytosis
clinical signs of too much histamine (flushing, itching, etc) and increased gastric acid production due to the increased histamine
43
Imperforate Anus
- commonly found with other genitourinary abnormalities
| - Also VACTERL (vertebral, anal atresia, tracheoesophageal fistula, esophageal atresia, renal and limb abnormalities
44
Abetalipoproteinemia
Fat accumulation at the tips of villi in the intestine because the fat cannot be put into the blood (it just accumulates in enterocytes)
- Will see acanthocytes in blood
45
Polyethylene Glycol
osmotic laxative (similar mechanism to lactase deficiency)
46
Motion Sickness Prevention
Antimuscarinics and antihistamines w/ antimuscarinic activity are most effective
47
Intergluteal Pilonidal Disease
acquired skin infection involing upper natal cleft of the buttocks, may present with draining sinus tracts
48
Volvulus
Midgut rotation around SMA failure
49
HepB Infected Hepatocyte Destruction
Host CD8 cytotoxic T cells kill hepatocytes because their cell surface presents hep B antigens
50
Hemorrhage due to Ulcer
- Lesser curvature: left gastric
| - Posterior duodenum: gastroduodenal
51
Diphenoxylate and Loperamide
- used as antidiarrheal by decreasing motility
- Acts at mu receptors (opioid) in GI tract
- Higher doses → euphoria and physical dependence
- Combine with atropine to prevent abuse
52
Signet Ring Cells
Diffuse Gastric Adenocarcinoma (mucus in cell pushes nucleus to side)
53
Acute Pancreatitis
Usually gallstones or alcohol, but can be from hypertriglyceridemia
54
SPINK1
Pancreatic trypsin inhibitor (prevents autodigestion of pancreas)
55
Mallory Weiss: metabolic effect
repetitive vomiting → metabolic alkalosis from vomiting up gastric acid
56
Fidoxamicin
(oral) for C. Diff has minimal systemic absorption and is bactericidal
(Vanco and metronidazole are bacteriostatic)
57
Lactase Deficiency
Increased stool osmolarity
Decreased stool pH, and Increased breath hydrogen
- lactase gene expression decreases/downregulated with age
58
Crohn's vs UC: T cells
Crohn’s: TH1 mediated (non-caseating granulomas)
| UC: TH2 mediated
59
Sporadic Colorectal Cancer mutations
APC → K-RAS → p53 & DCC
60
Arsenic or Polyvinyl Chloride
Liver hemangiosarcoma
| - Arsenic poisoning should be treated with Dimercaprol
61
Whipple's Disease
- T. Whippelii
- Foamy large macrophages filled with PAS+ granules and bacilli in small intestine mucosa
- Malabsorptive diarrhea and arthropathy
62
Salmonella Typhi
- typhoid fever
- travel followed by watery diarrhea that becomes blood (due to bowel perforation)
- salmon colored spotty rash on torso
63
Curling Ulcers
In burn patients
64
Cushing Ulcers
Related to head trauma
65
CYP 450 found in Zone
Zone 3
66
Peyers patches and largest number of goblet cells found in ____
Ileum
67
Intestinal Atresia
Apple peel atresia due to vascular accident
68
Above Pectinate Line
- Super rectal artery (of IMA)
- Superior rectal vein (to IMV – portal)
- Not painful (visceral innervation)
- Lymph drains to deep nodes
69
Below Pectinate Line
- Inferior and middle rectal artery (of pudendal artery)
- Inferior rectal vein (to internal pudendal → internal iliac → IVC – non-portal)
- Painful (somatic innervation, inf rectal branch of pudendal)
- Lymph drains to superficial inguinal nodes
70
Very low infectious inoculation
Giardia, Entaemoba, Shigella, and Campylobacter
71
Excess copper mainly excreted by:
hepatic excretion into bile, and partly through urine
72
D-xylose
- monosaccharide (doesn’t need action of pancreatic enzymes to be absorbed)
- Used to test for malabsorption
73
Ulcer Location: Zollinger Ellison vs Peptic Ulcer Disease
- Zollinger Ellison: distal duodenum
| - Peptic ulcer disease: proximal duodenum or lesser curvature of stomach
74
Portal Vein Thrombosis vs Budd Chiari
- Portal vein thrombosis does not cause any histologic changes to liver --> portal HTN
- Budd-Chiari (blocks hepatic vein) would have centrilobular congestion w/ portal HTN
75
Meconium Ileus
due to dehydrated mass of meconium blocking ileocecal valve caused by Cystic Fibrosis
76
Non-neoplastic GI polyps
Hamartomatous, Hyperplastic, and Inflammatory
| - no risk of transforming into cancer (unlike adenomatous polyps)
77
Pancreas: Ventral Bud
Main pancreatic duct (part), inferior and posterior part of the head, and the uncinate process
78
Pancreas: Dorsal Bud
Main pancreatic duct, body, tail, and most of the head
79
Left Sided Colon Cancer
Obstructive (infiltration of intestinal wall encircling the lumen) --> change in stool caliber, constipation, cramping pain, abdominal distension, nausea, and vomiting
80
Ride Sided Colon Cancer
Exophytic mass that does not develop obstruction (right side is larger)
- iron deficiency anemia due to ongoing blood loss, anorexia, weight loss, fatigue
81
PPIs
Block final common pathway of gastic acid secretion from parietal cells (so no effect with Ach via vagus, histamine, or gastrin)
- Histamine blockers only block the Histamine receptors and M3 blockers will only block the vagus effect
82
Diffuse Esophageal Spasms can mimic
Angina Pectoralis
83
Middle aged women w/ long history of pruritis and fatigue presenting w/ pale stool and xanthelasma
Primary Biliary Cirrhosis (PBC)
84
Male with long history of UC w/ fatigue and high alkaline phostphatase
Primary Sclerosing Cholangitis (PSC)
85
Pancreatic Pseudocyst
MC occurs after acute appendicitis
| -Round fluid filled space in parenchyma of pancreas (90% in tail)
86
Fibrosis between Nodules
Cirrhosis
| Regenerative nodules are made up of proliferating hepatocytes
87
Cryptosporidium in AIDS
Chronic watery diarrhea
88
High Estrogen in Cirrhosis
Spider angiomas, gynecomastia, testicular atrophy, decreased body hair, palmar erythema, and Dupuytren's contractures
89
"Crypt abscesses"
Seen with Ulcerative Colitis (UC)
- neutrophils accumulate in crypt lumina
erythematous, friable granular mucosa
90
Kayser Fleischer Rings
- aw/ Wilsons Disease
| - Brownish or gray-green rings of fine granular copper deposits in Descemets membrane of the Cornea
91
H. Pylori Gastric Ulcer
H. pylori produces proteases and particularly urease, which allow it to decrease the pH of the its local environment by cleaving urea into ammonia, which is toxic to gastric mucosa
92
Killing C. Difficile Spores
- Handwashing with soap is necessary
- Equipment should be autoclaved (steam) to clean it
- Alcohol-based rubs are not sufficient to kill the spores
93
Fluid in Lesser Sac
Fluid is contained in a space behind the stomach but in front of the retroperitoneal structures (e.g. the pancreas)
94
TIPs Procedure
Surgical portosystemic shunts to decrease Portal HTN
- MC is creating an intrahepatic shunt between the portal and hepatic veins
- can also anastomose the splenic vein to the nearby left renal vein
95
Gall bladder cannot be visualized on a radionuclide biliary scan
Acute Cholecystitis w/ gallstone obstruction of cystic duct
96
Chronic Mesenteric Ischemia
"intestinal angina"
Atherosclerosis of mesenteric arteries causing diminished blood flow to intestine after meals --> post-prandial epigastric pain
- aw/ food aversion and weight loss
97
Non-infective envelop glycoprotein that forms spheres and tubules 22 nm in diameter
HBsAg
| usually secretes in huge quantities
98
Nucleocapsid core and pre-core protein that is a marker of high infectivity
HBeAg
99
For Hepatitis D virus to infect:
the HBsAg of HepB must coat the HDAg of hepatitis D before it can infect hepatocytes and multiply
100
Most Dangerous Complication of UC
```
Toxic megacolon (can lead to perforation)
Do not do barium enema or colonoscopy
Can do an X-ray
```
101
Crohns: Oxalate Kidney Stones
Impaired bile acid absorption --> subsequent fat malabsorption -->lipids bind calcium ions and the soap complex is excreted --> free oxalate absorbed
- the oxalate is normally bound by calcium in the intestine so it gets excreted
102
Vagus on G cells
Releases GRP
